| NPI | 1073677720 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05394) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 1501146) |
| 363A00000X Physician Assistant (Licence: NY 23011075) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2019-11-22 |